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During our antibiotics teaching at medical school we were told that a recent survey of junior doctors had revealed that a significant proportion didn't realise that augmentin, tazocin, and carbopenems were penicillins and as such should not be given to those with known allergies. I devised a "mind-map" summarising the main antibiotics in use using information from the BNF and my own lecture notes. For me, seeing the information laid out in this manner, pinned above my desk as I work, helps me remember the major classes, their relationships with one another, and their major side-effects.

Maybe it’s just me, but I cannot get my head around pharmacology and antibiotics are certainly doing their best to finish me off! My group at uni decided that this was one area that we needed to revise, and the task fell on my hands to provide the material for a revision session. So, the night before the session I began to panic about how to come up with any useful tips for my group, or indeed anyone at all, to try to remember anything useful about antibiotics at all. If only Paracetamoxyfrusebendroneomycin was a real drug, it would make our lives so much easier. Come on Adam Kay and Suman Biswas, get the trials started and create your wonderful super drug. For the mean time I guess I will just have to keep blissfully singing along to your song. However, that is not going to help me with my task in hand.
After a lot of research that even took me beyond the realms of Wikipedia (something I do not often like to do), I found various sources suggesting remembering these Top 10 Rules (and their exceptions)
All cell wall inhibitors are ?-lactams (except vancomycin)
All penicillins are water soluble (nafcillin)
All protein synthesis inhibitors are bacteriostatic (aminoglycosides)
All cocci are Gram positive (Neisseria spp.)
All bacilli are Gram negative (anthrax, tetanus, botulism, diptheria)
All spirochetes are Gram negative
Tetracyclines and macrolides are used for intracellular bacteria
Pregnant women should not take tetracyclines, aminoglycosides,
fluroquinolones, or sulfonamides
Antibiotics beginning with a ‘C’ are particularly associated with
pseudomembranous colitis
While the penicillins are the most famous for causing allergies, people may also react to cephalosporins
If those work for you, then I guess you can stop reading now… If they don’t, I can’t promise that I have anything better, but give these other tips that I found a whirl… Alternatively, I have created a Page on my own blog called Rang and Dale’s answer to Antibiotics, which summarises their information, so please take a look at that.
Most people will suggest that you can categorise antibiotics in three ways, and it’s best to pick one and learn examples of them.
Mode of action:
bactericidal (kill)
bacteriostatic (stop multiplying)
2 mnemonics to potentially help you remember examples:
We’re ECSTaTiC about bacteriostatics?
Erythromycin Clindamycin Sulphonamides Tetracyclines Trimethoprim
Chloramphenicol
Very Finely Proficient At Cell Murder (bactericidal) - Vancomycin Fluroquinolones Penicillins Aminoglycosides Cephalosporins
Metranidazole
Spectrum of activity:
broad-spectrum (gram positive AND negative)
narrow (gram positive OR negative)
Mechanism of action
Inhibit cell wall synthesis
Inhibit nucleic acid synthesis
Inhibit protein synthesis
Inhibit cell membrane synthesis
If you have any more weird and wonderful ways to remember antibiotics, let me
know and I will add them! As always, thank you for reading.

Cranial Nerve 1- Olfaction
This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs.
Cranial Nerve 2- Visual acuity
This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage.
Cranial Nerve II- Visual field
The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex.
Cranial Nerve II- Fundoscopy
The first photograph is of a fundus showing papilledema. The findings of papilledema include
1. Loss of venous pulsation
2. Swelling of the optic nerve head so there is loss of the disc margin
3. Venous engorgement
4. Disc hyperemi
5. Loss of the physiologic cup an
6. Flame shaped hemorrhages.
This photograph shows all the signs except the hemorrhages and loss of venous pulsations.
The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination.
Images Courtesy Dr. Kathleen Digre, University of Uta
Cranial Nerves 2 & 3- Pupillary Light Refle
The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated.
Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini
and Dr. Kathleen Digre, University of Uta
Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen
This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball.
Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini
and Dr. Kathleen Digre, University of Uta
Cranial Nerves 3, 4 & 6- Versions
• The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy.
• The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye.
Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini
and Dr. Kathleen Digre, University of Uta
Cranial Nerves 3, 4 & 6- Duction
Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle.
Saccades
Smooth Pursui
The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder.
Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini
and Dr. Kathleen Digre, University of Utah
Optokinetic Nystagmu
This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion.
Vestibulo-ocular refle
The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level.
Vergenc
Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex.
Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini
and Dr. Kathleen Digre, University of Uta
Cranial Nerve 5- Sensor
There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline.
Cranial Nerves 5 & 7 - Corneal refle
A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction.
Cranial Nerve 5- Motor
• The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness.
• The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve.
First Video Courtesy of Alejandro Stern, Stern Foundation
Cranial Nerve 7- Motor
• The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve.
• The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion.
Video Courtesy of Alejandro Stern, Stern Foundatio
Cranial Nerve 7- Sensory, Tast
The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve.
Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test
This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss.
Cranial Nerve 8- Vestibula
Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation.
Cranial Nerve 9 & 10- Moto
When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves.
Video Courtesy of Alejandro Stern, Stern Foundatio
Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle
Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit.
Video Courtesy of Alejandro Stern, Stern Foundation
Cranial Nerve 11- Moto
When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve.
Video Courtesy of Alejandro Stern, Stern Foundation
Cranial Nerve 12- Moto
Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.

This session was designed to teach first year medical students about allergies and the basic medical management of anaphylaxis. The session was student led with a tutor in the audience to help provoke discussion and encourage students to participate. The session utilised an interactive smart-board with touch-screen function in order to get students involved in learning.
Although the information is not overly complex it is a good introduction to the topic and promoted student involvement as well as group interaction and teamwork.

Key: First line Second line Third line Penicillin allergy alternative (generally this is erythromycin or clarithromycin)) Remember that the doses below are adults doses; children’s doses (and also the drugs used for children) may be different.

Vitamin D deficiency has been associated with an ever expanding list of diseases, and with this has come almost tonic-like claims for vitamin D supplementation. In observational studies, low vitamin D status has been associated with increased risk of multiple sclerosis, type 1 and type 2 diabetes, cardiovascular disease, colon cancer, breast cancer, autoimmunity, and allergy.1 The UK government has advised that all pregnant women, and children under 5 years, should take 400 IU vitamin D daily; a recent news story, however, reported a survey conducted by a charity which suggested that only 26% of pregnant women and 46% of healthcare professionals are aware of these guidelines.2 The most recent musculoskeletal trend seems to be the attribution of childhood problems such as Blount’s disease and slipped femoral epiphyses to vitamin D deficiency and the incorrect conflation of rickets with low serum calcidiol (25-hydroxyvitamin D3) concentrations.3 So are health professionals causing ill health through their lack of awareness and advocacy of vitamin D supplementation?

ResearchToPractice.com/MTPH109 – Case 2 from the practice of Gracy Joshua, MD presented to Drs Gregory and Orlowski, moderated by Neil Love, MD. A woman in her early sixties with follicular lymphoma and a prior history of severe allergic reaction to rituximab experienced a complete remission with bendamustine/rituximab after disease progression on prior treatments with COP, fludarabine and single-agent rituximab. Produced by Research To Practice.

So you know you’re supposed to change your air filter regularly, generally every three months or even more frequently. But, life happens and often changing filters is something that we store in the back of our minds as we think about day-to-day life—work, kids and our social lives—and we might just forget.So what’s the danger in this? How will forgetting to change your air filter affect you, your family and anyone else who enters your home?Problem #1: You’ll experience a poorer quality of air in your home.Air filters &amp; AC filters works to trap harmful particles like mold, pet dander and bacteria that would otherwise pollute the air in your home. If a filter isn’t changed in due time, it will simply run out of room to collect more of these contaminants.Say you spill some juice. You grab a paper towel and cover the spill. After the first paper towel becomes too saturated to absorb more juice, you throw it away and grab and second one to continue cleaning up the spill. That second paper towel is necessary to keeping your home clean in the same way a new filter is.Problem #2 : Your HVAC system will work less efficiently, or not at all.In short, when you forget to change your air filter, contaminants like pollen and dust clog the filter and keep it from doing its job—cleaning the air that circulates throughout your home. And preventing your filter from doing the work it was deigned to do, not only keeps your HVAC system from doing the same, but also may harm it. and adds up to indoor air pollution which very harmful.Your HVAC system is powered by a fan motor that will have to work harder and harder to push air through a clogged filter. This additional pressure may cause the fan motor to overheat or even break entirely. Replacing a broken HVAC system will cost you—but so will letting an HVAC system run with a dirty filter. More work for the fan motor translates to higher charges on your electric bill. Additionally, a dirty evaporative (cooling) coil can dramatically reduce your airconditioners performance.Problem #3: You’ll inadvertently make your home dirtier.If your air filter becomes too clogged, the dust and dirt particles that it won’t be able to trap will simply recirculate throughout your home. This means dirt will collect quickly on surfaces within your house. Chances are, if you notice you’re dusting more frequently, it’s time to change your filter. No one wants to live in a dirty home, and cleaning more is certainly a pain, but it’s important to remember that the worst part of having more dirt in your home comes from breathing in that dirt. Failing to change your filter means living in an environment that will negatively affect your family’s health—especially if they have allergies, weak immune systems or other medical conditions.Furthermore, failing to change your filter can be negative for the environment as a whole. Remember, how clogged filters make your HVAC system work harder? As they expend more energy, your carbon footprint increases.Though changing your air filter may be an easy task to forget, it’s one that is important for your family’s health. You want to make sure the air they breathe is clean, especially if they suffer from allergies or conditions like asthma. If you need help remembering to change your air filter, try setting an alarm on your phone or marking your digital or paper calendar. Or you might align changing your filter with other important events on your calendar. Find one chore that you do every 3 months or more frequently depending on your needs, and plan to change your filter at the same time. If you’re noticing more dust in your home, or having more trouble with allergies than usual, you can take the hint that perhaps it’s time. When in doubt, just take your air filter out and see how dirty it looks. Changing your filter may be hard to remember, but the good news is, it’s a quick and easy way to improve your quality of life.